Abstract

Objective. Complications occur in diabetes despite rigorous efforts to control risk factors. Since 2000, the National Development Programme for the Prevention and Care of Diabetes has worked in order to halve the incidence of amputations in ten years. Here we evaluate the impact of the efforts undertaken by analyzing the major amputations done in 1997-2007.

Research Design and Methods. All persons with diabetes (n=396,317) were identified from comprehensive national databases. Data on the first major amputations (n=9,481) performed for diabetic and non-diabetic persons were obtained from the National Hospital Discharge Register.

Results. The relative risk for the first major amputation was 7.4 (95% CI 7.2-7.7) among the diabetic versus the non-diabetic population. The standardized incidence of the first major amputation decreased among the diabetic and non-diabetic populations (48.8% and 25.2% relative risk reduction, respectively) over eleven years, and the time from the registration of diabetes to the first major amputation was significantly longer, on average 1.2 years more. The cumulative five-year post-amputation mortality among diabetic persons was 78.7%.

Conclusions. In our nationwide diabetes database, the duration from the registration of diabetes to the first major amputation increased, and the incidence of major amputations decreased almost 50% in 11 years. About half of this change was due to the increasing size of the diabetic population. The risk for major amputation is over sevenfold that among the non-diabetic population. These results pose a continuous challenge to improve diabetes care.